Respiratory infections

In general, pneumonia in pregnancy is not more common than in the non-pregnant patient, but may be associated with increased complications. The pregnant patient is susceptible to the usual bacterial organisms that cause pneumonia. However, due to alterations in cell-mediated immunity, certain pulmonary infections may be more common or more severe, eg. influenza, varicella, and coccidioidomycosis.

Due to reluctance to perform X-rays in pregnancy, the diagnosis and treatment of pneumonia may be delayed, adversely affecting outcome. Antibacterial therapy is similar to treatment in the nonpregnant patient, but tetracyclines, quinolones and metronidazole should be avoided if possible. Erythromycin, azithromycin, and β-lactam antibiotics have a very good safety profile.

Pregnant women should receive influenza vaccination, due to the increased severity of illness in these patients. In most influenza pandemics, including the 2009 H1N1, pregnant women had a disproportionately high incidence of severe disease and respiratory failure. Early treatment with oseltamivir (Tamiflu) is beneficial.

The incidence of tuberculosis does not appear to be increased in pregnancy. Isoniazid, rifampin, and ethambutol have acceptable safety profiles in pregnancy and are the regimen recommended by the CDC. There is less clinical experience with pyrazinamide in pregnancy, but this drug is recommended by the WHO. Streptomycin should be avoided.